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Pharmacy, Volume 8, Issue 2 (June 2020) – 60 articles

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Cover Story (view full-size image) Inflammatory bowel disease (IBD) is a term used to describe a group of chronic intestinal [...] Read more.
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Open AccessArticle
The Significance of Taking Antiretroviral Medications for African-Born People Living with HIV and Residing in Minnesota
Pharmacy 2020, 8(2), 108; https://doi.org/10.3390/pharmacy8020108 - 26 Jun 2020
Viewed by 264
Abstract
Thanks to the development of antiretroviral (ART) medications, HIV is now a chronic and manageable disease. This study aimed to (1) capture the experiences of African-born persons living with HIV and taking antiretroviral treatment, and (2) explore the impact of social and cultural [...] Read more.
Thanks to the development of antiretroviral (ART) medications, HIV is now a chronic and manageable disease. This study aimed to (1) capture the experiences of African-born persons living with HIV and taking antiretroviral treatment, and (2) explore the impact of social and cultural factors on their decisions to follow the prescribed treatment. For this study, a qualitative approach was used. The participants were recruited via fliers, then screened for inclusion and exclusion criteria. Recruitment of the participants continued until data saturation occurred. The interview guide was developed based on the extensive literature and recommendations from the clinical team. In-person narrative interviews were conducted with 14 participants—African-born persons living with HIV and residing in Minnesota. Thematic Analysis revealed three emergent themes: “To exist I have to take the medicine”; barriers and facilitators in taking ART medications; and the power of spirituality and prayers. The findings of this study paint a picture of African-born persons living with HIV, and their experiences with ART medications. This study not only presents the participants’ medication experiences and their significance, but also tells their stories of how God and prayers play a significant role in helping them to get through the difficult moments of their lives. Full article
(This article belongs to the Special Issue Medication Experiences)
Open AccessArticle
The Mbeya Antimicrobial Stewardship Team: Implementing Antimicrobial Stewardship at a Zonal-Level Hospital in Southern Tanzania
Pharmacy 2020, 8(2), 107; https://doi.org/10.3390/pharmacy8020107 - 24 Jun 2020
Viewed by 306
Abstract
Background: In 2017, Mbeya Zonal Referral Hospital (MZRH) and the University of South Carolina (UofSC) agreed to collaboratively strengthen antimicrobial prescribing in the southern highlands of Tanzania and train a new generation of clinicians in responsible antimicrobial use. Methods: Key stakeholders and participants [...] Read more.
Background: In 2017, Mbeya Zonal Referral Hospital (MZRH) and the University of South Carolina (UofSC) agreed to collaboratively strengthen antimicrobial prescribing in the southern highlands of Tanzania and train a new generation of clinicians in responsible antimicrobial use. Methods: Key stakeholders and participants were identified and the Mbeya Antimicrobial Stewardship Team (MAST) was created. The team identified assets brought by the collaborators, and four investigations of baseline needs were developed. These investigations included (a) a baseline clinician survey regarding antimicrobial resistance and stewardship, (b) a serial chart review of inpatient antimicrobial prescribing practices, (c) an investigation of antimicrobial resistance rates using existing isolates at the MZRH laboratory, and (d) a survey of antimicrobial availability at community pharmacies in the city. Results: 91% of physicians believe antimicrobial resistance is problem in Tanzania, although only 29% of physicians were familiar with the term “antimicrobial stewardship”. Escherichia coli isolates had resistance rates of over 60% to the commonly used agents ciprofloxacin, trimethoprim-sulfamethoxazole, and ceftriaxone. Thirteen out of 14 community pharmacies offered over-the-counter antibiotics for upper respiratory symptoms. Conclusions: International antimicrobial stewardship collaborations can successfully identify opportunities and needs. Evaluating the team’s efforts to improve patient outcomes will be essential. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship across the Continuum of Care)
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Open AccessArticle
Implementation and Effectiveness of an Interprofessional Support Program for Patients with Type 2 Diabetes in Swiss Primary Care: A Study Protocol
Pharmacy 2020, 8(2), 106; https://doi.org/10.3390/pharmacy8020106 - 21 Jun 2020
Viewed by 396
Abstract
This research protocol illustrates the use of implementation science to support the development, dissemination and integration in primary care of effective and sustainable collaborative pharmacy services for chronic care management. The objective is to evaluate the implementation and the effectiveness of a pharmacist-led [...] Read more.
This research protocol illustrates the use of implementation science to support the development, dissemination and integration in primary care of effective and sustainable collaborative pharmacy services for chronic care management. The objective is to evaluate the implementation and the effectiveness of a pharmacist-led patient support program including regular motivational interviews; medication adherence, patient-reported outcomes, and clinical outcomes monitoring; and interactions with physicians, for patients with type 2 diabetes taking at least one oral antidiabetic medication in the French-speaking part of Switzerland. This is a prospective, multi-centered, observational, cohort study using a hybrid design to assess the patient support program. The evaluation includes three levels of analysis: (1) the implementation strategies, (2) the overall implementation process, and (3) the effectiveness of the program. Qualitative and quantitative methods are used, and outcomes are assessed at each stage of the implementation process: exploration, preparation, operation, and sustainability. This research project will provide key insights into the processes of implementing patient support programs on a large scale and adapting the traditional community pharmacy practices towards the delivery of person-centered and collaborative services. Full article
(This article belongs to the Special Issue Clinical Pharmacists' Interventions in Chronic Care)
Open AccessArticle
Emergency Contraception Access and Counseling in Urban Pharmacies: A Comparison between States with and without Pharmacist Prescribing
Pharmacy 2020, 8(2), 105; https://doi.org/10.3390/pharmacy8020105 - 19 Jun 2020
Viewed by 349
Abstract
Pharmacists are often the primary source of emergency contraception (EC) access and patient information. This study aims to identify differences in pharmacist-reported EC access and counseling between states which do or do not permit pharmacist-prescribed EC. This prospective, mystery caller study was completed [...] Read more.
Pharmacists are often the primary source of emergency contraception (EC) access and patient information. This study aims to identify differences in pharmacist-reported EC access and counseling between states which do or do not permit pharmacist-prescribed EC. This prospective, mystery caller study was completed in California (CA), which permits pharmacist-prescribed EC after completion of continuing education, and Georgia (GA), which does not. All community pharmacies that were open to the public in San Diego and San Francisco, CA, and Atlanta, GA were called by researchers who posed as adult females inquiring about EC via a structured script. Primary endpoints were EC availability and counseling. Statistical analyses completed with SPSS. Researchers called 395 pharmacies, 98.2% were reached and included. Regarding levonorgestrel (LNG), CA pharmacists more frequently discussed (CA 90.4% vs. GA 81.2%, p = 0.02), stocked (CA 89.5% vs. GA 67.8%, p < 0.01), and correctly indicated it “will work” or “will work but may be less effective” 4 days after intercourse (CA 67.5% vs. GA 17.5%, p < 0.01). Ulipristal was infrequently discussed (CA 22.6% vs. GA 3.4%, p < 0.01) and rarely stocked (CA 9.6% vs. GA 0.7%, p < 0.01). Pharmacists practicing in states which permit pharmacist-prescribed EC with completion of required continuing education may be associated with improved patient access to oral EC and more accurate patient counseling. Full article
(This article belongs to the Special Issue Pharmacist Contraception Services)
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Open AccessEditorial
Pharmacy Education; Competency and Beyond
Pharmacy 2020, 8(2), 104; https://doi.org/10.3390/pharmacy8020104 - 19 Jun 2020
Viewed by 230
Abstract
Competency-based curricula are the dominant approach in the education of healthcare professionals around the world today [...] Full article
(This article belongs to the Special Issue Pharmacy Education; Competency and beyond)
Open AccessReview
Ingestible Sensors and Medication Adherence: Focus on Use in Serious Mental Illness
Pharmacy 2020, 8(2), 103; https://doi.org/10.3390/pharmacy8020103 - 16 Jun 2020
Viewed by 293
Abstract
Background: Poor medication adherence is a major public health concern. Patients living with a serious mental illness (SMI) commonly present with non-adherence to their medication regimen, which can lead to relapse and hospitalizations. The high rates of antipsychotic non-adherence continue to persist despite [...] Read more.
Background: Poor medication adherence is a major public health concern. Patients living with a serious mental illness (SMI) commonly present with non-adherence to their medication regimen, which can lead to relapse and hospitalizations. The high rates of antipsychotic non-adherence continue to persist despite several interventions and medication advances. This review evaluates the possible role of the ingestible sensor technology for medication adherence in different conditions, with a focus on use in the SMI schizophrenia. Methods: Literature searches were conducted in July 2019 in the PubMed database. Results: In small studies of ingestible sensor use, the average adherence ranged from 73.9% to 88.6% for SMI and ≥ 80% for cardiac and transplant (99.4%) patients. In SMI studies, patients were clinically stable, and the majority had a clinical global impression severity of “mild disease”. Patients generally experienced relatively minor dermatological adverse effects related to wearable sensor use. Conclusions: A medication with an ingestible sensor may help provide real-time objective medication-taking adherence information for clinicians. However, further studies are needed to understand the impact of use on adherence and improvement on treatment outcomes with the ingestible sensor technology. Full article
(This article belongs to the Special Issue Psychotropic Medication Adherence)
Open AccessArticle
Travel Medicine Curricula across Canadian Pharmacy Programs and Alignment with Scope of Practice
Pharmacy 2020, 8(2), 102; https://doi.org/10.3390/pharmacy8020102 - 15 Jun 2020
Viewed by 419
Abstract
Limited research exists on pharmacy students’ training in travel medicine, and how this aligns with scope of practice. This research aimed to detail travel medicine education across pharmacy programs in Canada and map this against the scope of practice for pharmacists in each [...] Read more.
Limited research exists on pharmacy students’ training in travel medicine, and how this aligns with scope of practice. This research aimed to detail travel medicine education across pharmacy programs in Canada and map this against the scope of practice for pharmacists in each university’s jurisdiction. A survey based on the International Society of Travel Medicine’s Body of Knowledge was developed and distributed to all Canadian undergraduate pharmacy schools to identify topic areas taught, teaching modalities utilized, and knowledge assessment performed. Educational data was collected and analyzed descriptively, and compared to pharmacists’ scope of practice in the province in which each university is located. Training provided to students varied significantly across universities and topic areas, with topics amenable to self-care (e.g., traveller’s diarrhea and insect bite prevention) or also encountered outside of the travel context (e.g., sexually transmitted infections) taught more regularly than travel-specific topics (e.g., dengue and altitude illness). No apparent relationship was observed between a program’s curriculum and their provincial scope of practice. For example, training in vaccine-preventable diseases did not necessarily align with scope related to vaccine administration. Alignment of education to current and future scope will best equip new practitioners to provide care to travelling patients. Full article
(This article belongs to the Special Issue Travel Medicine - Series Ⅱ)
Open AccessArticle
Impact of Nasal Swabs on Empiric Treatment of Respiratory Tract Infections (INSERT-RTI)
Pharmacy 2020, 8(2), 101; https://doi.org/10.3390/pharmacy8020101 - 11 Jun 2020
Viewed by 343
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) polymerase-chain-reaction nasal swabs (PCRNS) are a rapid diagnostic tool with a high negative predictive value. A PCRNS plus education “bundle” was implemented to inform clinicians on the utility of PCRNS for anti-MRSA therapy de-escalation in respiratory tract infections (RTI). [...] Read more.
Methicillin-resistant Staphylococcus aureus (MRSA) polymerase-chain-reaction nasal swabs (PCRNS) are a rapid diagnostic tool with a high negative predictive value. A PCRNS plus education “bundle” was implemented to inform clinicians on the utility of PCRNS for anti-MRSA therapy de-escalation in respiratory tract infections (RTI). The study included patients started on vancomycin with a PCRNS order three months before and after bundle implementation. The primary objective was the difference in duration of anti-MRSA therapy (DOT) for RTI. Secondary objectives included hospital length of stay (LOS), anti-MRSA therapy reinitiation, 30-day readmission, in-hospital mortality, and cost. We analyzed 62 of 110 patients screened, 20 in the preintervention and 42 in the postintervention arms. Mean DOT decreased after bundle implementation by 30.3 h (p = 0.039); mean DOT for patients with a negative PCRNS decreased by 39.7 h (p = 0.014). Median cost was lower after intervention [USD$51.69 versus USD$75.30 (p < 0.01)]. No significant difference in LOS, mortality, or readmission existed. The bundle implementation decreased vancomycin therapy and cost without negatively impacting patient outcomes. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship across the Continuum of Care)
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Open AccessArticle
Preparing Pharmacists to Care for Patients Exposed to Intimate Partner Violence
Pharmacy 2020, 8(2), 100; https://doi.org/10.3390/pharmacy8020100 - 10 Jun 2020
Viewed by 348
Abstract
Intimate partner violence (IPV) is a serious, highly prevalent public health problem associated with poor health outcomes, negative impacts on medication behavior, and increased health care utilization and costs. Pharmacists, the most accessible health care providers, are the only provider group not required [...] Read more.
Intimate partner violence (IPV) is a serious, highly prevalent public health problem associated with poor health outcomes, negative impacts on medication behavior, and increased health care utilization and costs. Pharmacists, the most accessible health care providers, are the only provider group not required to be trained on this topic. Training can prepare pharmacists to safely and appropriately care for patients experiencing IPV. This project evaluated a pharmacy-specific continuing professional development module on IPV utilizing a quasi-experimental pretest–posttest study design. Practicing community pharmacists were recruited from a market research panel to complete the online module. A novel method for managing IPV disclosures, the Care, Assess for safety, Refer, and Document (CARD) method, was included in the training. A total of 36 pharmacists completed the study, including a three-month follow-up assessment. Participants reported increased perceived preparedness and knowledge, workplace and self-efficacy, staff preparation, and legal requirements, but not actual knowledge. Practice changes, including identification of legal reporting requirements (19.4%) and development of protocols for managing IPV disclosures (13.9%), were reported at follow-up. This is the first examination of an educational module on the topic of IPV for pharmacists and it positively impacted pharmacists’ preparedness and practice behaviors related to IPV over an extended follow-up period. Full article
(This article belongs to the Special Issue Continuing Professional Development in Pharmacy)
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Open AccessArticle
Attitudes of Michigan Female College Students about Pharmacists Prescribing Birth Control in a Community Pharmacy
Pharmacy 2020, 8(2), 99; https://doi.org/10.3390/pharmacy8020099 - 09 Jun 2020
Viewed by 338
Abstract
In the United States, the overall unintended pregnancy rate is about 45%. Women between 20–24 years old account for 59% of the unintended pregnancies. Continuous birth control use is related to decreasing unintended pregnancies. Therefore, we assessed female college students’ opinions about pharmacists [...] Read more.
In the United States, the overall unintended pregnancy rate is about 45%. Women between 20–24 years old account for 59% of the unintended pregnancies. Continuous birth control use is related to decreasing unintended pregnancies. Therefore, we assessed female college students’ opinions about pharmacists prescribing birth control in a community pharmacy using an intersectionality framework. A survey with 49 items about provider attributes, pharmacy services use and evaluation, advantages and barriers of pharmacists prescribing birth control, sexual and reproductive history, and demographics was distributed by survey link and QR code. Recruitment was done by investigators and students (snowballing technique) via emails, social media posts, and direct student contact. Respondents (n = 859) were 23.0 ± 4.9 years old, 83% white, 64% healthcare students, 32% student pharmacists, 69% sexually active, 68% with at least one episode of unprotected intercourse within a year, and 29% never using condoms. Forty-six percent of students were extremely likely and 26% moderately likely to get birth control from a pharmacist because it would be easier to adhere to birth control, could prevent unintended pregnancies, would be more convenient, and require less time. Concerns included the lack of Pap screenings and prescriptions written for the wrong birth control. Within most student characteristics or attitudes assessed, at least 70% of the students would use this service. Based on student opinions, female college students would use pharmacists prescribing birth control services. Full article
(This article belongs to the Special Issue Pharmacist Contraception Services)
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Open AccessEditorial
Pharmacy Technicians Help to Push Boundaries in Delivering Quality Care
Pharmacy 2020, 8(2), 98; https://doi.org/10.3390/pharmacy8020098 - 07 Jun 2020
Viewed by 334
Abstract
We are so pleased that Pharmacy dedicated a themed Special Issue to pharmacy workforce supportpersonnel, namely technicians [...] Full article
(This article belongs to the Special Issue Pharmacy Workforce Support Personnel)
Open AccessArticle
Pharmacy Technicians’ Roles and Responsibilities in the Community Pharmacy Sector: A Welsh Perspective
Pharmacy 2020, 8(2), 97; https://doi.org/10.3390/pharmacy8020097 - 04 Jun 2020
Cited by 1 | Viewed by 429
Abstract
Background: Healthcare delivery models in Wales are changing in response to unprecedented pressure on the National Health Service UK (NHS). Community pharmacies will be prioritised to address public health and clinical needs at a local level. To support the delivery of the new [...] Read more.
Background: Healthcare delivery models in Wales are changing in response to unprecedented pressure on the National Health Service UK (NHS). Community pharmacies will be prioritised to address public health and clinical needs at a local level. To support the delivery of the new model, pharmacy technicians must be enabled and developed to optimize their roles. The aim of the study was to establish existing roles of pharmacy technicians working in the community pharmacy sector in Wales and to explore barriers and enablers to development. Methods: A combination of quantitative and qualitative methodologies was used, with the main focus on quantitative methods. A total of 83 participants completed an online questionnaire and additional qualitative data were obtained from four semi-structured telephone interviews. Results: The dispensing and final accuracy checking of medicines were reported as core functions of the community pharmacy technician role, with an average of 43% and 57% of time being spent on these roles, respectively. There was some evidence of engagement in leadership and management roles (average of 19%) and limited evidence of delivery of services (average of 6%). Conclusions: There is scope to enable community pharmacy technicians to optimize and further develop their roles. Enablers include the effective use of delegation, workplace support, improved staffing levels and the prioritisation of extended pharmacy technician roles. Full article
(This article belongs to the Special Issue Pharmacy Workforce Support Personnel)
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Open AccessCase Report
Continuous Professional Development for Public Sector Pharmacists in South Africa: A Case Study of Mapping Competencies in a Pharmacists’ Preceptor Programme
Pharmacy 2020, 8(2), 96; https://doi.org/10.3390/pharmacy8020096 - 03 Jun 2020
Viewed by 355
Abstract
Lifelong learning among healthcare practitioners is crucial to keep abreast of advances in therapeutic and service delivery approaches. In South Africa, continuous professional development (CPD) was mandated (2019) for re-registration of pharmacists to illustrate their learning according to the South African Pharmacy Council’s [...] Read more.
Lifelong learning among healthcare practitioners is crucial to keep abreast of advances in therapeutic and service delivery approaches. In South Africa, continuous professional development (CPD) was mandated (2019) for re-registration of pharmacists to illustrate their learning according to the South African Pharmacy Council’s (SAPC) competency standards. This paper uses a preceptor programme linked to the University of the Western Cape School of Pharmacy’s service learning programme to map the competencies employed by pharmacist preceptors in primary care public healthcare facilities in Cape Town in an attempt to encourage completion of their annual CPDs and strengthening the academic-service partnership. Competencies identified were divided into input competencies related to the preceptor’s role in designing and implementing the educational programme in their facilities and assisting students to complete their prescribed learning activities, and output/outcome competencies that emerged from preceptors identifying the facility needs and employing their input competencies. Input competencies pertained to education, leadership, patient counselling, collaborative practice and human resources management. Output competencies related to pharmaceutical infrastructure, quality assurance, professional and health advocacy, primary healthcare, self-management and patient-centred care. The preceptor programme enabled pharmacist preceptors to employ several competencies that are aligned with the SAPC’s competency framework. Full article
(This article belongs to the Special Issue Continuing Professional Development in Pharmacy)
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Open AccessArticle
Pharmacist—Pharmacy Technician Intraprofessional Collaboration and Workplace Integration: Implications for Educators
Pharmacy 2020, 8(2), 95; https://doi.org/10.3390/pharmacy8020095 - 01 Jun 2020
Cited by 1 | Viewed by 473
Abstract
Globally, concerns have been expressed regarding the impact of regulation of pharmacy technicians. After more than a decade of experience with technician regulation in Ontario, Canada, uptake of the full scope of practice for technicians has been sporadic at best. The objective of [...] Read more.
Globally, concerns have been expressed regarding the impact of regulation of pharmacy technicians. After more than a decade of experience with technician regulation in Ontario, Canada, uptake of the full scope of practice for technicians has been sporadic at best. The objective of this study was to examine barriers and facilitators to intraprofessional collaboration between pharmacists and pharmacy technicians for the purpose of identifying possible curricular or educational interventions to enhance workplace integration. A qualitative, interview-based study of 24 pharmacists, technicians, educators, pharmacy managers, and owners was undertaken using a semi-structured interview guide. Key findings of this research include: (i) Confirmation of suboptimal utilization of regulated technicians in practice; (ii) identification of crucial knowledge and skills gaps for both pharmacists and technicians; and (iii) proposals for undergraduate education and training, and continuing professional development learning opportunities to address these gaps. In order to achieve the promise and potential of regulation of pharmacy technicians, system-wide change management—beginning with education—will be required and will benefit from multiple stakeholder engagement and involvement. Full article
(This article belongs to the Special Issue Pharmacy Workforce Support Personnel)
Open AccessArticle
Assessing the Travel Health Knowledge of Australian Pharmacists
Pharmacy 2020, 8(2), 94; https://doi.org/10.3390/pharmacy8020094 - 31 May 2020
Viewed by 467
Abstract
Worldwide, the numbers of travellers are increasing, with pharmacists having the potential to play a significant role in the provision of pre-travel health services to a large number of these travellers. However, studies examining whether pharmacists have the travel health knowledge to provide [...] Read more.
Worldwide, the numbers of travellers are increasing, with pharmacists having the potential to play a significant role in the provision of pre-travel health services to a large number of these travellers. However, studies examining whether pharmacists have the travel health knowledge to provide these services are limited. This study thus aimed to explore the travel health knowledge of Australian pharmacists. Surveys assessing pharmacists’ knowledge of travel health were distributed through the Pharmaceutical Society of Australia and community pharmacies for self-completion. Overall, the travel health knowledge of participants was found to be good. However, although the majority of participants were aware of the common causes of morbidity and mortality in travel health, some slightly overestimated the prevalence of malaria and were less knowledgeable about the global distribution of some diseases. Most participants also demonstrated an ability to give appropriate advice on the management of traveller’s diarhoea, the selection of appropriate items for inclusion in travel first aid kits, vaccinations, and malarial chemoprophylaxis for travellers visiting endemic areas. This study highlights that Australian pharmacists have the knowledge to deliver travel health advice, with the potential to improve both access and outcomes for travellers. Full article
(This article belongs to the Special Issue Travel Medicine - Series Ⅱ)
Open AccessArticle
Experiences Applying Technology to Overcome Common Challenges in Pharmacy Practice-Based Research in the United States
Pharmacy 2020, 8(2), 93; https://doi.org/10.3390/pharmacy8020093 - 30 May 2020
Viewed by 358
Abstract
Despite the importance of pharmacy practice-based research in generating knowledge that results in better outcomes for patients, health systems and society alike, common challenges to PPBR persist. Herein, we authors describe PPBR challenges our research teams have encountered, and our experiences using technology-driven [...] Read more.
Despite the importance of pharmacy practice-based research in generating knowledge that results in better outcomes for patients, health systems and society alike, common challenges to PPBR persist. Herein, we authors describe PPBR challenges our research teams have encountered, and our experiences using technology-driven solutions to overcome such challenges. Notably, limited financial resources reduce the time available for clinicians and researchers to participate in study activities; therefore, resource allocation must be optimized. We authors have also encountered primary data collection challenges due to unique data needs and data access/ownership issues. Moreover, we have experienced a wide geographic dispersion of study practices and collaborating researchers; a lack of trained, on-site research personnel; and the identification and enrollment of participants meeting study eligibility criteria. To address these PPBR challenges, we authors have begun to turn to technology-driven solutions, as described here. Full article
(This article belongs to the Special Issue Pharmacy Practice-based Research Networks)
Open AccessArticle
“Stigma and HIV Are Like Brother and Sister!”: The Experience of African-Born Persons Living with HIV in the US
Pharmacy 2020, 8(2), 92; https://doi.org/10.3390/pharmacy8020092 - 30 May 2020
Cited by 1 | Viewed by 389
Abstract
Minnesota has seen an increase in the number of immigrants from Africa, notably in the mid-1990s, making up around 2% of Minnesota’s total population. This population also faces many impediments that cause important difficulties not only for HIV prevention but also for treatment [...] Read more.
Minnesota has seen an increase in the number of immigrants from Africa, notably in the mid-1990s, making up around 2% of Minnesota’s total population. This population also faces many impediments that cause important difficulties not only for HIV prevention but also for treatment and care options. The objectives of this study were to capture the experiences of Persons Living with HIV (PLWH) in Minnesota (US) and to elicit their stories about their diagnosis news and what management strategies they use for coping with the stigma associated with the disease. Participants were recruited via fliers in pharmacies, clinics, and HIV service centers located in Minnesota. Recruitment continued until thematic saturation was obtained. Fourteen subjects participated in audio-recorded, semi-structured interviews that were transcribed verbatim into written text. The transcriptions were analyzed using Thematic Analysis. Three themes emerged from the data. Theme 1: Cruel News: “HIV-Oooooo! I wish I was dead”, Theme 2: This is My Secret! and Theme 3: “Stigma and HIV are brother and sister”. The results demonstrate that stigma is an ever-present problem in African-born PLWH living in the US. Participants perceived the stigma associated with HIV status to affect their lives and culture at individual, familial, and societal levels. Full article
(This article belongs to the Special Issue Medication Experiences)
Open AccessArticle
Are We Meeting the Demand for Pharmacist-Led Antimicrobial Stewardship Programs during Postgraduate Training-Year 1 (PGY1)?
Pharmacy 2020, 8(2), 91; https://doi.org/10.3390/pharmacy8020091 - 27 May 2020
Viewed by 448
Abstract
In the United States of America, pharmacists play a pivotal role in antimicrobial stewardship; training from postgraduate residency may hone knowledge and skills gained from didactic pharmacy education. Specifically, the first year of postgraduate training, the learner may become an “everyday steward in [...] Read more.
In the United States of America, pharmacists play a pivotal role in antimicrobial stewardship; training from postgraduate residency may hone knowledge and skills gained from didactic pharmacy education. Specifically, the first year of postgraduate training, the learner may become an “everyday steward in training” and may go on to complete a second year in infectious diseases. However, there are a limited number of second year infectious diseases programs. The current demand for pharmacist to participate in and or lead stewardship is disproportionate to available specialized training. The first year of post-graduate training has to be setup to ensure appropriate preparation, so newly trained pharmacist may help meet the demand. Currently, no clear standards exist for training in the first year. The purpose of this study is to survey the nature of stewardship training performed by first year residents from the perspective of residency program directors and preceptors. A 13-question online survey was distributed to examine resident exposure to antimicrobial stewardship activities. Survey data from targeted residency directors and preceptors were analyzed. A third of the programs required it as a mandatory rotation. Resident’s stewardship activities ranged from program to program; there was not consensus of the training activities. Full article
(This article belongs to the Special Issue Pharmacy Education Development)
Open AccessArticle
Qualitative Exploration of Pharmacists’ Feedback Following the Implementation of an “Allergic Rhinitis Clinical Management Pathway (AR-CMaP)” in Australian Community Pharmacies
Pharmacy 2020, 8(2), 90; https://doi.org/10.3390/pharmacy8020090 - 26 May 2020
Viewed by 402
Abstract
Allergic Rhinitis (AR) is both a common and high burden disease, with the majority of AR sufferers purchasing suboptimal/inappropriate AR medication from community pharmacies. Unfortunately, it is still a challenge to translate the AR management guidelines that are available at both a global [...] Read more.
Allergic Rhinitis (AR) is both a common and high burden disease, with the majority of AR sufferers purchasing suboptimal/inappropriate AR medication from community pharmacies. Unfortunately, it is still a challenge to translate the AR management guidelines that are available at both a global and national level into practice. This study aimed to explore the experiences and perceptions of community pharmacists with regards to the implementation of AR management guidelines in real-life everyday practice. This exploration took the form of a qualitative research study in which pharmacists were interviewed following the implementation of a guideline-driven AR management pathway in their pharmacies. Fifteen pharmacists from six pharmacies agreed to participate in a telephone interview. Five themes were identified that encompassed the sentiment of the pharmacists during the interviews: (1) impact of training on pharmacists’ approach to patients and AR management recommendations; (2) patient engagement and the importance of appropriate tools; (3) patient barriers to change in practice; (4) physical, logistical, and inter-professional barriers to change within the pharmacy environment; and (5) recommendations for improvement. The results of this study indicate that, following the implementation of an AR management pathway, pharmacists believe that their interactions with patients around their AR were enhanced through the use of appropriate tools and education. However, if optimal AR management is to be delivered within the community pharmacy setting, the undertaking needs to be collaborative with both pharmacy assistants and general practitioners. Full article
(This article belongs to the Special Issue Medicine Use in Upper Respiratory Airways and Asthma)
Open AccessArticle
The Role of Community Pharmacists in the Detection of Clinically Relevant Drug-Related Problems in Chronic Kidney Disease Patients
Pharmacy 2020, 8(2), 89; https://doi.org/10.3390/pharmacy8020089 - 22 May 2020
Viewed by 604
Abstract
Community pharmacists (CPs) have traditionally had limited access to patients’ estimated glomerular filtration rate (eGFR) during the medication-dispensing process. The increasing access to shared electronic health records is making eGFR available, but the skills needed to detect and manage clinically relevant drug-related problems [...] Read more.
Community pharmacists (CPs) have traditionally had limited access to patients’ estimated glomerular filtration rate (eGFR) during the medication-dispensing process. The increasing access to shared electronic health records is making eGFR available, but the skills needed to detect and manage clinically relevant drug-related problems (DRPs) are poorly documented. The primary objective of this study was to investigate the role of CPs in the medication-dispensation process for elderly patients with renal impairment. A total of 70 CPs participated in this 6 month study. Community pharmacists asked all patients ≥65 years to bring their laboratory test values for the next medication-dispensing process. Drug-related problem detection rates were compared between CPs (prospective period) and expert pharmacists (retrospectively). The clinical relevance of each DRP was assessed by nephrologists and general practitioners using an appropriate tool. Community pharmacists recruited n = 442 patients with eGFR < 60 mL/min/1.73 m2 and detected n = 99 DRPs, whereas expert pharmacists detected n = 184 DRPs. The most frequently detected DRPs were dosage problems and contraindications. According to assessment by clinicians, CPs and expert pharmacists identified 54.0% and 84.7% of clinically relevant DRPs, respectively. This study suggests a positive impact of the systematic availability of eGFR to CPs on the detection of several DRPs with clinical relevance. Full article
(This article belongs to the Special Issue Pharmacokinetics of Drugs and Dosing in Kidney Disease)
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Open AccessArticle
Description of Position Ads for Pharmacy Technicians
Pharmacy 2020, 8(2), 88; https://doi.org/10.3390/pharmacy8020088 - 22 May 2020
Cited by 1 | Viewed by 464
Abstract
Pharmacy technician roles are evolving alongside the changing role of a pharmacist. There is currently no uniform definition of a pharmacy technician’s role in the pharmacy workforce. The objective of this study was to look at the United States-based pharmacy technician advertisement database [...] Read more.
Pharmacy technician roles are evolving alongside the changing role of a pharmacist. There is currently no uniform definition of a pharmacy technician’s role in the pharmacy workforce. The objective of this study was to look at the United States-based pharmacy technician advertisement database from Pharmacy Week to find patterns and commonalities in the duties and qualifications of pharmacy technicians. A retrospective analysis was performed on fourteen days of pharmacy technician job listings from Pharmacy Week from the year 2018. Information obtained from the listings included job title, location, setting, type of job, job duties, and job requirements. Job duties and requirements were coded by themes. Fourteen days of data resulted in 21,007 individual position listings. A majority of the job listings were for full-time positions (96.4%) and most were in the retail setting (96.78%). The most common requirements were registration with State Board, high school diploma, ability to perform tasks, communication, and physical. The most common job duties were general office etiquette, performing tasks under the direct supervision of the pharmacist, and professionalism. This study provides a description of the evolving role of pharmacy technicians through the broad variety in expectations for requirements of pharmacy technician applicants and the duties they perform when hired. Full article
(This article belongs to the Special Issue Pharmacy Workforce Support Personnel)
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Open AccessArticle
Association of a Novel Medication Risk Score with Adverse Drug Events and Other Pertinent Outcomes Among Participants of the Programs of All-Inclusive Care for the Elderly
Pharmacy 2020, 8(2), 87; https://doi.org/10.3390/pharmacy8020087 - 20 May 2020
Viewed by 1015
Abstract
Preventable adverse drug events (ADEs) represent a significant public health challenge for the older adult population, since they are associated with higher medical expenditures and more hospitalizations and emergency department (ED) visits. This study examines whether a novel medication risk prediction tool, the [...] Read more.
Preventable adverse drug events (ADEs) represent a significant public health challenge for the older adult population, since they are associated with higher medical expenditures and more hospitalizations and emergency department (ED) visits. This study examines whether a novel medication risk prediction tool, the MedWise Risk Score™ (MRS), is associated with ADEs and other pertinent outcomes in participants of the Programs of All-Inclusive Care for the Elderly (PACE). Unlike other risk predictors, this tool produces actionable information that pharmacists can easily use to reduce ADE risk. This was a retrospective cross-sectional study that analyzed administrative medical claims data of 1965 PACE participants in 2018. To detect ADEs, we identified all claims that had ADE-related International Classification of Diseases and Health Related Problems, 10th revision (ICD-10) codes. Using logistic and linear regression models, we examined the association between the MRS and a variety of outcomes, including the number of PACE participants with an ADE, total medical expenditures, ED visits, hospitalizations, and hospital length of stay. We found significant associations for every outcome. Specifically, every point increase in the MRS corresponded to an 8.6% increase in the odds of having one or more ADEs per year (OR = 1.086, 95% CI: 1.060, 1.113), $1037 USD in additional annual medical spending (adjusted R2 of 0.739; p < 0.001), 3.2 additional ED visits per 100 participants per year (adjusted R2 of 0.568; p < 0.001), and 2.1 additional hospitalizations per 100 participants per year (adjusted R2 of 0.804; p < 0.001). Therefore, the MRS can risk stratify PACE participants and predict a host of important and relevant outcomes pertaining to medication-related morbidity. Full article
(This article belongs to the Section Clinical Pharmacy)
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Open AccessArticle
Medication Complexity among Disadvantaged African American Seniors in Los Angeles
Pharmacy 2020, 8(2), 86; https://doi.org/10.3390/pharmacy8020086 - 16 May 2020
Viewed by 505
Abstract
Background. Several publications highlight data concerning multiple chronic conditions and the medication regimen complexity (MRC) used in managing these conditions as well as MRCs’ association with polypharmacy and medication non-adherence. However, there is a paucity of literature that specifically details the correlates [...] Read more.
Background. Several publications highlight data concerning multiple chronic conditions and the medication regimen complexity (MRC) used in managing these conditions as well as MRCs’ association with polypharmacy and medication non-adherence. However, there is a paucity of literature that specifically details the correlates of MRC with multimorbidity, socioeconomic, physical and mental health factors in disadvantaged (medically underserved, low income) African American (AA) seniors. Aims. In a local sample in South Los Angeles, we investigated correlates of MRC in African American older adults with chronic disease(s). Methods. This was a community-based survey in South Los Angeles with 709 African American senior participants (55 years and older). Age, gender, continuity of care, educational attainment, multimorbidity, financial constraints, marital status, and MRC (outcome) were measured. Data were analyzed using linear regression. Results. Higher MRC correlated with female gender, a higher number of healthcare providers, hospitalization events and multimorbidity. However, there were no associations between MRC and age, level of education, financial constraint, living arrangements or health maintenance organization (HMO) membership. Conclusions. Disadvantaged African Americans, particularly female older adults with multimorbidity, who also have multiple healthcare providers and medications, use the most complex medication regimens. It is imperative that MRC is reduced particularly in African American older adults with multimorbidity. Full article
(This article belongs to the Special Issue Polypharmacy)
Open AccessArticle
Managing Allergic Rhinitis in the Pharmacy: An ARIA Guide for Implementation in Practice
Pharmacy 2020, 8(2), 85; https://doi.org/10.3390/pharmacy8020085 - 16 May 2020
Viewed by 634
Abstract
The paradigm of how we manage allergic rhinitis is shifting with a growing understanding that it is a complex process, requiring a coordinated effort from healthcare providers and patients. Pharmacists are key members of these integrated care pathways resolving medication-related problems, optimizing regimens, [...] Read more.
The paradigm of how we manage allergic rhinitis is shifting with a growing understanding that it is a complex process, requiring a coordinated effort from healthcare providers and patients. Pharmacists are key members of these integrated care pathways resolving medication-related problems, optimizing regimens, improving adherence and recommending therapies while establishing liaisons between patients and physicians. Community pharmacists are the most accessible healthcare professionals to the public and allergic rhinitis is one of the most common diseases managed by pharmacists. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines developed over the past 20 years have improved the care of allergic rhinitis patients through an evidence-based, integrated care approach. In this paper, we propose an integrated approach to allergic rhinitis management in community pharmacy following the 2019 ARIA in the pharmacy guidelines. Full article
(This article belongs to the Special Issue Medicine Use in Upper Respiratory Airways and Asthma)
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Open AccessReview
A Narrative Review of Continuing Professional Development Needs for Pharmacists with Respect to Pre-exposure Prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV)
Pharmacy 2020, 8(2), 84; https://doi.org/10.3390/pharmacy8020084 - 11 May 2020
Viewed by 680
Abstract
Pre-exposure prophylaxis (PrEP) for the human immunodeficiency virus (HIV) is rapidly increasing in use worldwide, with many countries now publicly funding use for high risk populations. Pharmacists, as front-line care providers, must have the necessary knowledge, skills and attitudes to effectively provide care [...] Read more.
Pre-exposure prophylaxis (PrEP) for the human immunodeficiency virus (HIV) is rapidly increasing in use worldwide, with many countries now publicly funding use for high risk populations. Pharmacists, as front-line care providers, must have the necessary knowledge, skills and attitudes to effectively provide care to PrEP patients. The aim of this review was to identify priority areas and key gaps for continuing professional development (CPD) needs relating to PrEP for practicing pharmacists. An electronic search of PubMed, EMBASE, International Pharmaceutical Abstracts and CPD-related journals was supplemented with a manual search of references to identify articles describing pharmacists’ knowledge, perceptions and experience with PrEP. A total of eight articles were identified across four countries. Pharmacists were consistently found to lack knowledge and awareness of PrEP, express low confidence/comfort with patient care practices, report a lack of experience and/or intentions to provide patient care, but overall had positive perceptions of PrEP therapy. Older pharmacists with more experience commonly reported greater knowledge gaps than recently trained pharmacists. CPD should therefore aim to increase pharmacists’ baseline knowledge and awareness of PrEP and treatment guidelines, as well as be directed towards older pharmacists with more experience. Full article
(This article belongs to the Special Issue Continuing Professional Development in Pharmacy)
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Open AccessArticle
Measuring the Development of Therapeutic-Decision-Making Skills by Practicing Pharmacists Undertaking a University-Based Postgraduate Clinical Qualification at Distance
Pharmacy 2020, 8(2), 83; https://doi.org/10.3390/pharmacy8020083 - 11 May 2020
Viewed by 505
Abstract
(1) Background: The processes and skills required to make decisions about drug therapy have been termed “therapeutic decision-making” in pharmacy practice. The aim of this study was to evaluate a tool constructed to measure the development of therapeutic-decision-making skills by practicing pharmacists undertaking [...] Read more.
(1) Background: The processes and skills required to make decisions about drug therapy have been termed “therapeutic decision-making” in pharmacy practice. The aim of this study was to evaluate a tool constructed to measure the development of therapeutic-decision-making skills by practicing pharmacists undertaking a university-based continuing professional development program. (2) Methods: A pre- and post-intervention crossover study design was used to investigate the qualitative and quantitative features of practicing pharmacists’ responses to two clinical vignettes designed to measure the development of therapeutic-decision-making skills. The vignettes were assigned a score using a five-point scale and compared pre- and post-intervention. (3) Results: There was a median increase in score of 2 units on the five-point scale in the post-intervention scores compared to pre-intervention (p < 0.0001). (4) Conclusions: The results were interpreted to suggest that the participants’ responses to the vignettes are a reasonable measure of student learning. Therefore, we infer that the teaching and learning intervention successfully enabled the development of therapeutic-decision-making skills by practicing pharmacists. Full article
(This article belongs to the Special Issue Continuing Professional Development in Pharmacy)
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Open AccessCommentary
Pharmacists and Contraception in the Inpatient Setting
Pharmacy 2020, 8(2), 82; https://doi.org/10.3390/pharmacy8020082 - 09 May 2020
Viewed by 476
Abstract
The choice of contraceptive method should be based on patient specific factors, patient preference, and method-specific properties. In this article, we review opportunities for an inpatient clinical pharmacist to assist in the selection and counseling of contraceptives in hospitalized patients. An inpatient pharmacist [...] Read more.
The choice of contraceptive method should be based on patient specific factors, patient preference, and method-specific properties. In this article, we review opportunities for an inpatient clinical pharmacist to assist in the selection and counseling of contraceptives in hospitalized patients. An inpatient pharmacist has the opportunity to discuss various contraceptive methods with the patient, ensuring an appropriate method is used after discharge, which is especially important after the occurrence of a contraception-related adverse effect or contraindication to certain contraceptive methods. Barriers, such as formulary restrictions, can limit inpatient initiation of contraceptive therapy while hospitalized, but pharmacists can provide education on appropriate alternatives. Inpatient clinical pharmacists can also make recommendations for contraceptive methods in special populations. It is crucial to select an appropriate therapy in patients with an underlying medical condition, such as those with active or history of breast cancer, psychiatric disorder, or thrombophilia, as inappropriate therapy can cause an increased risk of harm. Pharmacists can assist in contraceptive counseling, evaluating for drug-drug and drug-disease interactions, and recommending the most appropriate therapy in special populations. An inpatient pharmacist has the opportunity to interact with the medical team and assist in navigation of teratogenic medication use and Risk Evaluation and Mitigation Strategies. Full article
(This article belongs to the Special Issue Pharmacist Contraception Services)
Open AccessCommentary
Rethinking Competence: A Nexus of Educational Models in the Context of Lifelong Learning
Pharmacy 2020, 8(2), 81; https://doi.org/10.3390/pharmacy8020081 - 08 May 2020
Viewed by 903
Abstract
Competency-based education (CBE) “derives a curriculum from an analysis of a prospective or actual role in modern society and attempts to certify students’ progress on the basis of demonstrated performance in some or all aspects of that role”. This paper summarizes pertinent aspects [...] Read more.
Competency-based education (CBE) “derives a curriculum from an analysis of a prospective or actual role in modern society and attempts to certify students’ progress on the basis of demonstrated performance in some or all aspects of that role”. This paper summarizes pertinent aspects of existing CBE models in health professions education; pharmacy education presented as an example. It presents a synthesis of these models to propose a new diagrammatic representation. A conceptual model for competency-based health professions education with a focus on learning and assessment is discussed. It is argued that various elements of CBE converge to holistically portray competency-based learning and assessment as essential in initial education and relevant to practitioners’ continuing professional development, especially in the context and importance of pursing lifelong learning practices. Full article
(This article belongs to the Special Issue Continuing Professional Development in Pharmacy)
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Open AccessReview
Interventions Delivered in the Community Pharmacy to Manage Allergic Rhinitis- A Systematic Review of the Literature
Pharmacy 2020, 8(2), 80; https://doi.org/10.3390/pharmacy8020080 - 06 May 2020
Viewed by 505
Abstract
Pharmacists have a valuable role in the management of allergic rhinitis (AR) at the community pharmacy level. This role has been reported extensively in numerous papers. However, a systematic review of the available literature and a comprehensive analysis of the outcomes has not [...] Read more.
Pharmacists have a valuable role in the management of allergic rhinitis (AR) at the community pharmacy level. This role has been reported extensively in numerous papers. However, a systematic review of the available literature and a comprehensive analysis of the outcomes has not been published. This systematic review aimed to evaluate the impact of interventions developed by pharmacists on clinical AR outcomes. A thorough search was performed in three electronic databases, including studies published between January 2000 and June 2019. After the selection process, only three articles met the inclusion criteria and were further analysed. Despite the scarcity of the available studies, in all of them was clear that the pharmacist plays a pivotal role in the management of AR, significantly improving the patients’ quality of life and symptom control. This systematic review also stresses the utmost importance to investigate and report practices and interventions developed by pharmacists using measurable outcomes. Full article
(This article belongs to the Special Issue Medicine Use in Upper Respiratory Airways and Asthma)
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Open AccessArticle
Implementing an Online Longitudinal Leadership Development Program Using a Leadership-Specific Continuing Professional Development (CPD) Tool
Pharmacy 2020, 8(2), 79; https://doi.org/10.3390/pharmacy8020079 - 06 May 2020
Viewed by 521
Abstract
As the roles of a pharmacist continue to evolve, leadership is an imperative skill for pharmacists to advance in their profession. To advance leadership behaviors, a number of tools, programs, and services have been developed worldwide to encourage the use of these behaviors [...] Read more.
As the roles of a pharmacist continue to evolve, leadership is an imperative skill for pharmacists to advance in their profession. To advance leadership behaviors, a number of tools, programs, and services have been developed worldwide to encourage the use of these behaviors in practice. A brief summary of different leadership opportunities around the globe are provided. A continuing professional development process and tool for developing and mentoring leaders that are ready to take the next step in their growth journey is introduced. This tool can be used in a live or online setting and is amenable to a longitudinal environment for leadership development and mentoring. A detailed process for implementing an online leadership development program and opportunities for future development are also described. While leadership skills can be developed in many ways, it is still unclear which methods and tools are the most effective in training pharmacists to maximize their leadership abilities. Additional research on effectiveness and impact of tools and processes for development are needed. Individuals and organizations are encouraged to consider implementing easily accessible leadership development and mentoring programs to advance the leadership skills of interested individuals. Full article
(This article belongs to the Special Issue Continuing Professional Development in Pharmacy)
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